Predictors of Aggressive Behavior While under the Influence of Illicit Drugs among Young Adult Methamphetamine Users

Background: Prior research indicates that patterns of combined alcohol and methamphetamine use may be associated with experiencing subjective feelings of aggression or hostility during methamphetamine use episodes. Objectives: This study examines whether subjective effects of methamphetamine use (i.e., aggression or hostility and paranoia) are associated with aggressive behavior while under the influence of any illicit drugs, controlling for combined alcohol and methamphetamine use and a number of other potential predictors. Methods: Data from a population-based sample of Australian young adult methamphetamine users (n = 101) collected in 2010 was analyzed. A prediction model of aggressive behavior under the influence of illicit drugs was developed using penalized maximum likelihood logistic regression. Results: Over one-third (34.7%) of methamphetamine users had engaged in verbal and/or physical aggression under the influence of illicit drugs in the last 12 months. In the prediction model, recurrent feelings of aggression or hostility attributed to methamphetamine use (≥3 times in the last 12 months) were associated with aggressive behavior (adjusted odds ratio 4.95, 95% confidence interval 1.67, 14.69). This association was independent of methamphetamine-attributed paranoia, combined alcohol and methamphetamine use, methamphetamine, ecstasy, cocaine, and cannabis use patterns, heavy episodic drinking, gender, and age. No association was found for combined alcohol and methamphetamine use. Conclusions: These findings indicate a link between methamphetamine-related subjective feelings of aggression or hostility and self-reported aggressive behavior while under the influence of illicit drugs. This suggests that subjective feelings of aggression or hostility may distinguish those who are involved in aggression from other methamphetamine users.     

All-cause mortality among individuals with disorders related to the use of methamphetamine: A comparative cohort study

Background

Understanding the mortality rate of methamphetamine users, especially in relation to other drug users, is a core component of any evaluation of methamphetamine-related harms. Although methamphetamine abuse has had a major impact on United States (US) drug policy and substance-abuse treatment utilization, large-scale cohort studies assessing methamphetamine-related mortality are lacking.

Methods

The current study identified cohorts of individuals hospitalized in California from 1990 to 2005 with ICD-9 diagnoses of methamphetamine- (n = 74,139), alcohol- (n = 582,771), opioid- (n = 67,104), cannabis- (n = 46,548), or cocaine-related disorders (n = 48,927), and these groups were followed for up to 16 years. Age-, sex-, and race-adjusted standardized mortality rates (SMRs) were generated.

Results

The methamphetamine cohort had a higher SMR (4.67, 95% CI 4.53, 4.82) than did users of cocaine (2.96, 95% CI 2.87, 3.05), alcohol (3.83, 95% CI 3.81, 3.85), and cannabis (3.85, 95% CI 3.67, 4.03), but lower than opioid users (5.71, 95% CI 5.60, 5.81).

Conclusions

Our study demonstrates that individuals with methamphetamine-use disorders have a higher mortality risk than those with diagnoses related to cannabis, cocaine, or alcohol, but lower mortality risk than persons with opioid-related disorders. Given the lack of long-term cohort studies of mortality risk among individuals with methamphetamine-related disorders, as well as among those with cocaine- or cannabis-related conditions, the current study provides important information for the assessment of the comparative drug-related burden associated with methamphetamine use.     

Lifetime Doctor-Diagnosed Mental Health Conditions and Current Substance Use Among Gay and Bisexual Men Living in Vancouver,Canada

Background: Studies have found that gay, bisexual, and other men who have sex with men (GBM) have higher rates of mental health conditions and substance use than heterosexual men, but are limited by issues of representativeness. Objectives: To determine the prevalence and correlates of mental health disorders among GBM in Metro Vancouver, Canada. Methods: From 2012 to 2014, the Momentum Health Study recruited GBM (≥16 years) via respondent-driven sampling (RDS) to estimate population parameters. Computer-assisted self-interviews (CASI) collected demographic, psychosocial, and behavioral information, while nurse-administered structured interviews asked about mental health diagnoses and treatment. Multivariate logistic regression using manual backward selection was used to identify covariates for any lifetime doctor diagnosed: (1) alcohol/substance use disorder and (2) any other mental health disorder. Results: Of 719 participants, 17.4% reported a substance use disorder and 35.2% reported any other mental health disorder; 24.0% of all GBM were currently receiving treatment. A lifetime substance use disorder diagnosis was negatively associated with being a student (AOR = 0.52, 95% CI [confidence interval]: 0.27–0.99) and an annual income ≥$30,000 CAD (AOR = 0.38, 95% CI: 0.21–0.67) and positively associated with HIV-positive serostatus (AOR = 2.54, 95% CI: 1.63–3.96), recent crystal methamphetamine use (AOR = 2.73, 95% CI: 1.69–4.40) and recent heroin use (AOR = 5.59, 95% CI: 2.39–13.12). Any other lifetime mental health disorder diagnosis was negatively associated with self-identifying as Latin American (AOR = 0.25, 95% CI: 0.08–0.81), being a refugee or visa holder (AOR = 0.18, 95% CI: 0.05–0.65), and living outside Vancouver (AOR = 0.52, 95% CI: 0.33–0.82), and positively associated with abnormal anxiety symptomology scores (AOR = 3.05, 95% CI: 2.06–4.51). Conclusions: Mental health conditions and substance use, which have important implications for clinical and public health practice, were highly prevalent and co-occurring.     

Evaluation of dystonia in children and adolescents treated with atomoxetine within the Truven MarketScan database: a retrospective cohort study

Objective: Atomoxetine is a non-stimulant drug indicated for the treatment of attention-deficit/hyperactivity disorder in children aged ≥6 years, adolescents, and adults. In this retrospective cohort study, the incidence and risk of dystonia in children and adolescents treated with atomoxetine was compared to a propensity score-matched cohort of stimulant users.

Methods: Data between 1 January 2006 and 31 December 2014 from patients aged 6–17 years in the Truven Health Analytics MarketScan database were used to generate two cohorts of patients: (1) atomoxetine users and (2) stimulant (methylphenidates or amphetamines) users. A Cox proportional hazards regression model was used to compare incidence of dystonia across propensity score-matched cohorts.

Results: Of the 70,657 atomoxetine users, 70,655 users were propensity score-matched to a stimulant user. In the atomoxetine- and stimulant-treated cohorts, the crude incidence rates of dystonia were 54.9 (95% CI: 27.1–82.7) and 77.9 (95% CI: 49.1–106.8) per 100,000 person-years, respectively. The hazard ratio for occurrence of dystonia with atomoxetine use relative to stimulant use was 0.68 (95% CI: 0.36 ? 1.28; P = 0.23).

Conclusion: In this large retrospective cohort study, there was no significant difference in incidence or risk of dystonia among patients treated with atomoxetine compared to stimulants.     

Higher smoking prevalence among United States adults with co-occurring affective and drug use diagnoses

IntroductionIndividuals with drug use disorders or affective disorders have higher cigarette smoking prevalence and smoking intensity and are less likely to quit than the general population. We sought to estimate the prevalence of cigarette smoking by drug use and psychiatric diagnoses and to explore to what extent a co-occurring diagnosis was associated with current smoking.MethodsData were derived from the most recent National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III, 2012–2013; n = 36,309). Cigarette smoking status was examined among those with any past-year or lifetime drug use disorders (i.e., alcohol, cannabis, opioid, cocaine) or affective disorders (i.e., mood, anxiety). Diagnoses were assessed using the Diagnostic and Statistical Manual of Mental Disorders criteria (DSM-5).ResultsAdjusting for sociodemographic characteristics, those with drug use disorders (past-year AOR = 3.3, 95% CI: 3.0, 3.6; lifetime AOR = 3.2, 95% CI: 3.0, 3.5) and those with affective disorders (past-year AOR = 1.7; 95%CI: 1.5, 1.8, lifetime AOR = 1.3, 95% CI: 1.2; 1.4), had higher odds of current cigarette smoking compared to individuals with no diagnosis. The odds of current cigarette smoking was significantly higher in individuals with both drug use disorders and affective disorders compared to those with either a drug use or affective disorder or no disorder (past-year AOR = 5.1; 95% CI: 4.3, 5.9, lifetime AOR = 4.3; 95% CI: 3.8, 4.7).ConclusionsApproximately 30% of the population had a past-year drug use or affective disorder, 17% of whom report both. The combination of both diagnoses produced a 1.5 to 3-fold higher correlation with smoking than either alone.     

Cigarette,smokeless tobacco,and alcohol use among transgender adults in the United States

BackgroundResearch suggests that sexual minority adults face disparate risks for poor health outcomes. However, prior research on transgender populations has been limited by small and nonprobability samples and has potentially masked important differences between transgender subgroups. We examined disparities in cigarette, smokeless tobacco, and alcohol consumption by transgender and cisgender adults.Methods2014–2017 Behavioral Risk Factor Surveillance System data were used. Multivariable logistic regressions examined differences in cigarette, smokeless tobacco, and alcohol use between cisgender adults and transgender sub-identities: male to female (MTF), female to male (FTM), and gender nonconforming.ResultsCigarette and smokeless tobacco use were higher among transgender adults. The gender nonconforming subgroup reported more binge and heavy drinking. In a multivariable logistic analysis, higher odds of smokeless tobacco use were found for all transgender sub-identities compared to cisgender females. The gender nonconforming group had higher odds of heavy drinking (AOR = 2.09, 95% CI 1.14–3.82) and binge drinking (AOR = 1.94, 95% CI 1.25–3.02) compared to cisgender females. The MTF subcategory was more likely to binge drink (AOR = 1.88, 95% CI 1.44–2.46) compared to cisgender females. The FTM subcategory had lower odds of binge drinking (AOR = 0.49, 95% CI 0.33-0.73) compared to cisgender males.ConclusionsSignificant heterogeneity in smokeless tobacco and alcohol use were found among transgender subgroups, particularly when compared to cisgender females. Our findings demonstrate that it is important to consider sub-identities in both the transgender population and in the reference cisgender population.     

Alcohol-related problem behaviors among Latin American immigrants in the US

BackgroundPrior research indicates that Latino immigrants are less likely than US-born individuals to use alcohol and meet criteria for an alcohol use disorder. However, our understanding of alcohol-related problem behaviors among Latino immigrants remains limited. We report the prevalence of alcohol-related problem behaviors among Latino immigrants vis-à-vis the US-born and examine the relationship between alcohol-related problem behavior and key migration-related factors and injury/receipt of emergency medical care.MethodsThe data source used for the present study is the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III, 2012–2013), a nationally representative survey of 36,309 civilian, non-institutionalized adults ages 18 and older in the US. Logistic regression was employed to examine the relationship between immigrant status and key outcomes.ResultsForeign-born Latinos were less likely to report one or more alcohol-related problems compared to US-born Latinos (AOR = 0.41, 95% CI = 0.33–0.50) and the US-born general population (AOR = 0.38, 95% CI = 0.32–0.46). Latino immigrants arriving as children were, compared to those arriving later in life, significantly more likely to report alcohol-related problem behaviors, and experiences of discrimination were linked with greater risk of alcohol-related problem behavior as well. Latino immigrants reporting recurrent injury/emergency medical care utilization were more likely to report alcohol-related problem behavior.ConclusionsLatino immigrants are significantly less likely than US-born Latinos and the US-born general population to operate a vehicle under the influence of alcohol, take part in risky behaviors or fight while drinking, or to be arrested due to alcohol consumption.     

Marijuana and Alcohol Use and Attempted Smoking Cessation in Adolescent Boys and Girls

ABSTRACT. Background: This study sought to determine the relationship between the frequency of current marijuana and alcohol use and cigarette quit attempts in male and female adolescent smokers. Methods: Data from a cross-sectional survey of health behaviors in high-school-aged adolescents were analyzed. Current cigarette smokers (n = 804) who reported use of at least 1 cigarette in the past month were divided into those with and without a history of at least 1 quit attempt (a self-reported episode of trying to “stop smoking”). Logistic regression models were fit to describe the association between the frequency of marijuana/alcohol use and a history of cigarette quit attempts. Results: Among the total sample, higher-frequency marijuana use (more than 6 times in the past 30 days) and frequent binge drinking (more than 5 days of binge drinking in the past 30 days) decreased the odds of having a past cigarette quit attempt (higher-frequency marijuana: adjusted odds ratio [AOR] = 0.56, 95% confidence interval [CI] = 0.36–0.86; frequent binge drinking: AOR = 0.49, 95% CI = 0.29–0.83). A significant gender interaction was observed for the relationship between higher-frequency marijuana use and a history of cigarette quit attempts (P = .03), with decreased odds in boys (AOR = 0.41, 95% CI = 0.22–0.77) but not in girls (AOR = 0.71, 95% CI = 0.37–1.33). Conclusions: Adolescent smokers who report higher-frequency marijuana use or frequent binge drinking have a decreased likelihood of a history of a cigarette quit attempt. The gender-related association between higher-frequency marijuana use and a history of quit attempts suggests that boys with greater substance use may need particularly intensive support to initiate quit attempts.     

Physical Factors,Personal Characteristics,and Substance Use: Associations With Obesity

ABSTRACT. Background: Because obesity has become a major public health problem, attention to a range of its predictors is needed. This study examined the association of physical factors, personal characteristics, and substance use with obesity in a sample (N = 815) of African American and Puerto Rican young adults with a mean age of 32. Methods: Body mass index (BMI) was calculated to assess obesity. Bivariate and multivariate logistic regression analyses were conducted. Results: Bivariate analyses showed that protective factors such as physical activity (adjusted odds ratio [AOR] = .82, 95% confidence interval [CI] = .74–.91), healthy diet (AOR = .96, 95% CI = .93–.99), self-control (AOR = .93, 95% CI = .87–.98), and life satisfaction (AOR = .97, 95% CI = .95–.99) were associated with a reduced probability of being obese. Marijuana use was also associated with a decreased probability of obesity (AOR = .89, 95% CI = .80–.99), but was not considered a protective factor. Risk factors such as short sleep duration (AOR = 1.70, 95% CI = 1.24–2.33) and depressive mood (AOR = 1.05, 95% CI = 1.01–1.09) were associated with an increased probability of being obese. Conclusions: For African Americans and Puerto Ricans, programs to treat obesity should focus on increasing sleep, physical activity, and life satisfaction.     

Contemplation of smoking cessation and quit attempts in human immunodeficiency virus–infected and uninfected veterans

ABSTRACT

Background: As antiretroviral treatments prolong life in human immunodeficiency virus (HIV)-infected patients, smoking cessation is now a top priority. However, studies of HIV-infected smokers have not been conducted with uninfected controls. In this study, researchers determined factors associated with contemplating smoking cessation and making a prior quit attempt among HIV-infected and uninfected smoking veterans. Methods: Between 2005 and 2007, 1,027 HIV-infected and 794 uninfected smokers were identified as part of the Veterans Aging Cohort Study (VACS). Stratifying by HIV status, adjusted odds ratios (AORs) were calculated using logistic regression to identify factors associated with contemplating smoking cessation and making a prior quit attempt. Results: Most participants (66 % of HIV-infected vs. 68 % of uninfected; P = .46) were contemplating cessation, and 56 % of both groups (P = .99) had attempted to quit in the last year. In stratified multivariable analyses, HIV-infected smokers with recent pulmonary disease diagnoses were more likely to have made a quit attempt (AOR = 4.93, 95 % confidence interval [CI] = 1.41–17.17). Both HIV-infected and uninfected patients with unhealthy alcohol use were less likely to be contemplating cessation (AOR = 0.66, 95 % CI = 0.49–0.90 and 0.71, 95 % CI = 0.50–1.00). HIV-infected smokers who reported unhealthy alcohol use were also less likely to have made a quit attempt in the last year (AOR = 0.68, 95 % CI = 0.51–0.91). Conclusions: Patient-level interest and motivation are not major barriers to smoking cessation among HIV-infected veterans. Targeting HIV-infected smokers with a recent pulmonary disease diagnosis may improve sustained smoking cessation. Unhealthy alcohol use appears to be a key modifiable risk factor. Smoking cessation rates may be improved by combining interventions for smoking and alcohol use for HIV-infected patients.     

Sociodemographic and Substance Use Correlates of Gambling Behavior in the Canadian General Population

ABSTRACT

This study describes sociodemographic and substance use correlates of gambling behaviors, measured among 9,481 past-year gamblers from the Canadian general population. Compared to non-problem gamblers in this study (N = 8,035), the 98 problem gamblers who scored 8 or more points on the Canadian Problem Gambling Research Index were more likely to report being “drunk or high” while gambling (adjusted odds ratio [AOR]: 8.92; 95% confidence interval [CI]: 5.46,14.55; p < .001), to admit to having an alcohol or drug problem (AOR: 3.80; 95% CI:2.21,6.52; p < .001), and to use electronic gambling devices (AOR: 4.85; 95% CI: 3.08-7.66; p< .001).     

Depression treatment patterns among adults with chronic obstructive pulmonary disease and depression

Objective: To estimate rates and patterns of depression treatment among adults with chronic obstructive pulmonary disease (COPD) and depression.

Methods: We used a retrospective, cross-sectional study design, pooling data from 2010 and 2012 Medical Expenditure Panel Survey (MEPS). The study sample consisted of 527 individuals aged 21 years or older, diagnosed with COPD and depression. Depression treatment was grouped into three categories based on those who received: (1) neither antidepressant nor psychotherapy; (2) antidepressants only; and (3) psychotherapy combined with antidepressants (combination therapy). We conducted chi-squared tests and multinomial logistic regressions to examine factors (demographic, socio-economic characteristics, healthcare access, health status, and personal health practices) associated with depression treatment among adults with COPD and depression.

Key findings: The mean age of the study sample was 55.96 years (SD?=?13.36). Overall, 18.8% of the sample adults did not report any use of antidepressants or psychotherapy, 58.3% reported antidepressants use only and 23% reported using combination therapy. Females (adjusted odds ratio [AOR]?=?1.89, 95% CI?=?1.02, 3.55), older adults (≥65 years: AOR?=?3.69, 95% CI?=?1.62, 8.41), adults with fair/poor physical health status (AOR?=?3.32, 95% CI?=?1.29, 8.56) and those suffering from anxiety (AOR?=?1.94, 95% CI?=?1.09, 3.46) were more likely to receive antidepressant treatment. Older adults (AOR =2.94, 95% CI =?1.05, 8.22), those who were never married (AOR?=?3.17, 95% CI?=?1.18, 8.56), suffered from anxiety (AOR =6.01, 95% CI?=?3.11, 11.61) and current smokers (AOR?=?2.29, 95% CI?=?1.05, 4.98) were more likely to receive combination therapy. Whereas, adults who were uninsured (AOR?=?0.21, 95% CI?=?0.05, 0.86) and did not lacked regular physical activity (AOR?=?0.33, 95% CI?=?0.16, 0.67) were less likely to receive combination therapy. A key limitation of our study is that we could not control for the severity of depression or COPD which may have influenced depression treatment.

Conclusion: Efforts to improve depression care among adults with co-occurring COPD and depression may need to be tailored for different subgroups.     

Brand Preferences of Underage Drinkers Who Report Alcohol-Related Fights and Injuries

Background: A significant body of research has demonstrated an association between adolescent alcohol consumption and subsequent fights and injuries. To date, however, no research has identified which brands are associated with alcohol-related fights and injuries among underage drinkers. Objectives: We aimed to: (1) report the prevalence of alcohol-related fights and injuries among a national sample of underage drinkers in the U.S. and (2) describe the relationship between specific alcohol brand consumption and these alcohol-related negative consequences. Methods: We recruited 1,031 self-reported drinkers (ages 13–20 years) via an internet panel maintained by Knowledge Networks to complete an online survey. Respondents reported their past-month overall and brand-specific alcohol consumption, risky drinking behavior, and past-year alcohol-related fights and injuries. Results: Over one-quarter of the respondents (26.7%, N = 232) reported at least one alcohol-related fight or injury in the past year. Heavy episodic drinkers were over six times more likely to report one of these negative alcohol-related consequences (AOR: 6.4, 95% CI: 4.1–9.9). Respondents of black race and those from higher-income households were also significantly more likely to report that experience (AOR: 2.2, 95% CI: 1.3–3.7; AOR: 1.8, 95% CI: 1.1–3.0 and 1.1–3.2, respectively). We identified eight alcohol brands that were significantly associated with alcohol-related fights and injuries. Conclusions/Importance: Alcohol-related fights and injuries were frequently reported by adolescent respondents. Eight alcohol brands were significantly more popular among drinkers who experienced these adverse consequences. These results point to the need for further research on brand-specific correlates of underage drinking and negative health outcomes.     

Amphetamine-Type-Stimulants (ATS) Use and Homosexuality-Related Enacted Stigma Are Associated With Depression Among Men Who Have Sex With Men (MSM) in Two Major Cities in Vietnam in 2014

Background: Men who have sex with men (MSM) are disproportionately affected by mental health concerns, including depression. Amphetamine-type-stimulants (ATS) use and homosexuality-related stigma and discrimination have been found associated with depression among MSM. Objectives: To assess the prevalence of depression and its associations with ATS use and homosexuality-related stigma and discrimination among MSM in Vietnam. Methods: 622 MSM were conveniently recruited in Hanoi and Ho Chi Minh city, Vietnam, from September to December 2014. We collected information on demographic characteristics, ATS, alcohol and other drug use, sexual behaviors, homosexuality-related and discrimination stigma, and sexual sensation-seeking. Depression and suicidal thoughts were assessed by the Patient Health Questionnaire (PHQ-9). We assessed associations of depression with ATS use and homosexuality-related stigma and discrimination using logistic regression. Results: Of 622 sampled MSM, 11.3% were classified as having major depression, 9.8% reported any suicidal thoughts in the last two weeks, 30.4% ever had used any ATS, 88.8% ever ad drank alcohol and 21.5% had ever used any other drugs. In multivariate analysis, depression was significantly associated with ATS use (Adjusted Odds Ratio [AOR: 2.20; (95% Confidence Interval (CI): 1.32–3.67], younger age of sexual debut with another man (AOR: 0.09; 95% CI: 0.02–0.50), and greater enacted homosexuality-related stigma (AOR: 1.97; 95% CI: 1.19–3.26). Conclusions: We found a moderate prevalence of depression among sampled MSM, which was associated with ATS use and enacted homosexuality-related stigma. We recommend integrating assessment and interventions regarding depression and methamphetamine use into gay-friendly, culturally adapted holistic HIV prevention for MSM in Vietnam.     

Age of Sexual Debut and Cannabis Use in the United States

Background: Understanding the interrelationships between risky health behaviors is critical for health promotion efforts. Conceptual frameworks for understanding substance misuse (e.g. stepping-stone models) have not yet widely incorporated other risky behaviors, including those related to sexual health. Objectives: The goals of this study were to assess the relationship between early sexual debut and cannabis use, examine the role of licit substance use in this association, and evaluate differences by gender and race/ethnicity. Methods: Data came from the National Comorbidity Survey-Replication (NCS-R). Primary analysis was restricted to respondents who reported sexual debut at ≥12 years (n = 5,036). Age at sexual debut was categorized as early (<18 years), average (18 years) and late (>18 years). Logistic regression was used to assess the relationship between age at sexual debut and cannabis use. Interaction terms were used to evaluate effect modification by gender and race/ethnicity. Results: Later age of sexual debut was associated with lower odds of cannabis use relative to the average age of debut (AOR = 0.50, 95% CI = 0.37–0.66). For every year that respondents delayed their sexual debut, the relative odds of lifetime cannabis use declined by 17%. After accounting for alcohol and tobacco use the association between early sexual debut and cannabis was attenuated (AOR = 0.90, 95% CI = 0.68–1.20), while later age of debut remained protective (AOR = 0.57, 95% CI = 0.42–0.78). Results were generally consistent across race/ethnicity and gender. Conclusions: Multifactorial intervention strategies targeting both sexual health and substance use may be warranted.     

A comparison of alcohol and drug use by random motor vehicle drivers in Brazil and Norway

BackgroundA large proportion of road traffic crashes are related to driving under the influence (DUI) of alcohol or drugs. The aim of this study was to compare the use of alcohol, illegal drugs and psychoactive medicinal drugs among random drivers in Brazil and Norway, two countries with the same legal limit for drunk driving, but with marked differences in legislation history, enforcement and penalties for DUI, and to discuss any differences found.MethodsRoadside surveys were conducted on Fridays and Saturdays between noon and midnight. Samples of oral fluid were collected for analysis of drugs, whereas alcohol was determined by breath testing or by analysis of oral fluid.ResultsHigh participation rates of 94–97% were obtained in both countries. The weighted prevalence of driving with alcohol concentrations in breath or oral fluid equivalent to blood alcohol concentrations (BAC) above 0.2 g/L was 2.7% (95% CI 2.2–3.3) in Brazil and 0.2% (95% CI 0.0–0.5) in Norway. Stimulants (amphetamines or cocaine) were found in samples from 1.0% (95% CI 0.7–1.4) of drivers in Brazil and 0.3% (95% CI 0.1–0.7) in Norway. The prevalence of amphetamines was highest among Brazilian truck drivers (3.6%; 95% CI 2.0–6.4). Tetrahydrocannabinol was found in samples from 0.5% (95% CI 0.3–0.8) of drivers in Brazil and 1.0% (95% CI 0.6–1.5) in Norway, whereas benzodiazepines or zopiclone were found in 1.0% (95% CI 0.7–1.4) and 1.7% (95% CI 1.2–2.4) of the samples from Brazil and Norway, respectively.ConclusionsThe difference in the prevalence of alcohol may be related to the fact that Norway has implemented steps to reduce drunk driving since 1936, whereas Brazil has attempted to do the same for only a few years. Differences for drugs may be related to different patterns in the use of stimulants, cannabis and medicines.     

Frequent emergency department presentations among people who inject drugs: A record linkage study

BackgroundPeople who inject drugs (PWID) have been described as frequent users of health services such as emergency departments (EDs), however few studies have described demographic factors, patterns of substance use and previous health service use associated with frequent use of EDs in this population.MethodsUsing a combination of self-reported data from a cohort of PWID and administrative ED data obtained through record linkage, we identified longitudinal factors associated with the use of ED services. Bivariate and multivariate analyses were conducted using negative binomial regression to identify exposures associated with both cumulative ED presentations, and logistic regression to identify exposures of frequent ED presentations (defined as three or more annual presentations).ResultsAmong 612 PWID, over half (58%) presented to EDs at least once and over a third (36%) presented frequently between January 2008 and June 2013. Frequent and cumulative ED presentations were associated with reporting the main drug of choice as cannabis (AOR:1.42, 95%CI:1.07–1.89 and AIRR:2.96, 95%CI:1.44–6.07 respectively) or methamphetamine (AOR:1.62, 95%CI:1.17–2.2 and AIRR:2.42, 95%CI:1.08–5.46 respectively) compared to heroin, and past month use of mental health (AOR:1.42, 95%CI:1.08–1.85 and AIRR:3.32, 95%CI:1.69–6.53 respectively) and outpatient services (AOR:1.47, 95%CI: 1.00–2.16 and AIRR:0.95, 95%CI 1.52–10.28 respectively).ConclusionPWID who are frequent users of EDs are likely to have complex health and substance use-related needs. EDs should actively refer people who present with cannabis and methamphetamine dependence to harm reduction services. Harm reduction services should ensure people referred from EDs are screened for co-occurring mental health conditions and receive adequate support.     

Comparison of Substance Use and Risky Sexual Behavior Among a Diverse Sample of Urban,HIV-Positive Men Who Have Sex with Men

ABSTRACT

The purpose of this study was to examine substance use among a racially and ethnically diverse group of HIV-positive men who have sex with men (MSM) living in six U.S. cities, model associations between drug use and serodiscordant unprotected anal intercourse (SDUAI), and characterize users of the substances strongly associated with risky sexual behavior. Baseline questionnaire data from 675 participants of the Positive Connections intervention trial were analyzed. Overall, substance use was common; however, the highest percentage of stimulant (30%), methamphetamine (27%), and popper (i.e., amyl nitrite) (46%) use was reported among white MSM and crack/cocaine (38%) use was highest among African American MSM. Popper use versus non-use (odds ratio = 2.46; 95% confidence interval = 1.55–3.94) and condom self-efficacy (1 standard deviation (sd) increase on scale; odds ratio = .58; 95% confidence interval = .46–.73) were significantly associated with SDUAI after adjusting for key demographic and psychosocial factors. These results highlight the importance of addressing drug use in the context of sex for possible HIV transmission risk.